HomeMy WebLinkAboutT12N R3W SEC 33 LT 115 E PTN E110' OF THE S183' BLM LT 115
NAME
~4AILING ADDRESS
LEGAL DESCRIPTION
LOCATION
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 1-elephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE [~N E~W--W-'
, I°C) 0 L, .1~= HOMEMADE:
DISTANCE TO: LWell
I Manufacturer ....
DISTANCE O: IWe'' ¢oo"
j No. of lines j J Length~f each line
Top of die [o finish grade
Length Width
Type of crib CNb diameter
-- Well
DISTANCE TO:
Clas~ ' ' .
~ Depth
J [~[STANCE l-O:
ZA '°r,'t,r va TD e"i Z
Inside length J Width
Dwellin9
Material
Total le~.~t~,f lines Trench ~Jd.~,
Depth
Crib depth
Building foundation
Driller
Building foundatlon Sewer line
NO. OF BEDROOMS
PERMIT NO.
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Distance between lines
PERMIT NO.
JTotal e~fectJve absorption area
Distance, to lot line
Septic t~
PER M~rgoo~ 3_~
Absorption area(si
OTHER
PIPE MATERIALS
b. o3q
SOIL TEST RATING
REMARKS
APPROVED DATE
LEGAL
I
72-013 (Rev. 3/78)
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"Or.t :r:! i~ '~<r.~,l'. '~ l[-~'~'~d
220,; C]e~.:-,~ ~d ?_nchorage, ~lass.a 99503
urfor:;ed For _.. ~LL'd~.t.,~ /-Ot/<~f'~' Date Performed "7" //"
(.~a 1 qescrintion: Lot ~l oc k __Subfliv~s~on ...... .
Percolation Test
his Form Renorts Soils [.oq..~ ?~f
new, th
Fr, et Soil ghar~cterisi:i~ ....
Ground Water Encountered? At what Denth?_/~( .........
]6 -
Was
]~ Yes,
, ........................
pe-colation Rate _-
z' prnposed Inst~]~tion: Seenaae Pit Drain Field
Bep{h ~6 '~OtTom Of Pit O'~'?~6CH
Denth of Inlet
/
Time
Date
Insp
MUNICIPALITY OF ANCHORAG~
DEPARTM[ OF 4EALTH AND ENVIRONMEN ~ ~ROTECTION
825 L Street, Anchorage. Alaska 99501
264-4720
Date Received: February 16, 1978
lli~ a.m. ~2: Time ~;..;~zD ~ #3: Time
2-~78 Tuesday Date ~%~q]-'7~ /~Q~. Date
Pr~t Insp :P~p,c~/. Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska Bank of Commerce
Mailing Address: 741 West 4th Avenue 99501. Phone:
279-5641
349-3303
2. Property Owner: Shirley Chugg
Mailing Address: Star Route A Box 4024
99507
Phone:
3. Legal Description: T12N R3W Section 33 Portion 115
Single Family Residence: (x) Number of Bedrooms: One
Multiple Family Residence: ( ) Number of Bedrooms:
Well System: Individual Well ~ Community/Public System ( )
Permit :~ Depth of Well _ Well Log on File
Construction Bacterial Analysis
Sewage Disposal Sysnem: On-site System (x) Public Utility ( )
Permit Installed 19627 Installer
Septic Tank Size Manufacturer
Absorption Area Soils Rate ~ Material
( )
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page Two
Department of
Request for Approval
Legal Description: T12N R3W
Comments:
Health and Environmental Protection
of Individual Sewer and Water Facilities
Section 33 Portion of 115
Affadavit Attached: ) Letter Attached: ( )
Approved: Date:
Disapproved: Date:
Department Worksheet:
MUNICIPALITY OF ANCHORAG.
Department of Health and Environmental Protection
825 L Street, Anchorage, Alaska 99501
~equest for Approval of Individual Sewer and Water Facilities
Property Owner: Shirley ChuKK
Mailing Address: SRA Box 4024, ~¢hora~e. Ak 99507
2. Name of Buyer: Jon W. Flint
279-6077 -
Phone: 279-5641
Phone: 274-856]
Public/Community System
(x) Public System
Approximately 19627
Mailing Address: 1410 W. 36th Ave. #2, Anchorage. Ak995~h°ne:
Lending Institution: Alaska BaDk of Commerce (Main Branch]
Mailing Address: 712 W 4 Ave
Realtor/Agent: SKYWAY REALTY COMPANY (Gene N~ erstbe~meJa)
Mailing Address: 3202 Spenard Rd.
Legal Description: T12N R~W Sen 3% Pot.
Street Location: Porc_upine Trail
Single Family Residence: (x) Number of Bedrooms: 1
Multiple Family Residence: ( ) Number of Bedrooms:
Water Supply: * Individual Well
If Individual Well, well depth Unknown
If Community System, name of system
Sewage Disposal System: *~Dn-site System
If On-site System, date of installation:
*NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
'test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
06-1220(a) Rev. 1973
DATE
ALA, DEPARTMENT OF HEALTH AND SOCIAL SL ,;ES
DIVISION OF PUBLIC HEALTH
INDIVIDUAL AND SEMI-PUBLIC
BACTERIOLOGICAL WATER ANALYSIS
Lab No.
OFFICE
4AME
iNDiVIDUAL J~]
SEMI-PURLIC [] CHLORINE RESIDUAL PPM
REPORT RESULTS TO
CITY ' ZIP CODE
ADDRESS
OF SOURCE
COMPLETE THIS SECTION
ONLY IF WI~TER IS AN INDIVIDUAL SUPPLY
SAMPLE COLLECTED BY i ~ '' !'
DATE COLLECTED - : ~ TIME COLLECTED __ "/ '
SOURCE: ~ Spring [~ Cislern [] Other
LOCATION:
[] Of Well [] Other _
Analysis shows this Water SAMPLE to be:
~ ~coJsfaclor y
[] Unsatisfactory
[] Questionable
L~ Sample too long Jn transit; sample should not be over 48
liours old at examination to indicate rellable results. Please
send new sample.
[] Boltle broken in transit, please send new sample.
SANITARIAN'S REMARKS
PURPOSE OF EXAMINATION: illness Suspected?
New Source of Supply? [] Yes
READ INSTRUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
[] No
[] Yes [] No Signature
o6.m~o (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. 1973
actose Broth 10cc 10cc 10cc 10cc 10cc 1,0=c 1.0cc
24 Hours
48 Hours -
48 Hours